Case study #1:
OHDSI in Europe
Christian Reich
QuintilesIMS
Overview
•Experience so far
– EMIF
– QuintilesIMS
– RxNorm Extension
• European OHDSI Chapter
2
EMIF
3
EMIF: Participating Data Owners
4
EMIF: Standard ETL Process
•Local and CDM team together
5
EMIF Support for data custodians
Medical knowledge
ETL Development
Database /
Infrastructure
management
Project Coordination
CDM Knowledge (Local) Data
knowledge
Local
EMIF
Depending on
preferences & available
skills, EMIF can take on
different roles
SIDIAP: Information System for Development
of Research in Primary Care.
8
●2010: IDIAP Jordi Gol (UAB Primary Care Research Inst.) +
Catalan Institute of Health (Government of Catalonia)
● One primary care health provider using one same e-records
software (eCAP)
● 289 Primary Care Centres in Catalonia
● >5,8 million people (80% population)
● >3,400 GPs
● >40 million person-years of research-usable data (2006
onwards)
Slides Leonardo Méndez Boo
Integrated Primary Care
Information (IPCI)
9
•Project started in 1989
•Data from general practitioners (GP)
•GP is gatekeeper for medical care in NL
•Mixture of city and country practices
475 practices
372 active practices
601 active general practitioners
1.900.000 research patients
1.000.000 active patients
19.160.000 patient years
5.658.000 research quality years
(16.800.000 citizens in The Netherlands)
Feedback from EMIF Experience
1. Mixed local/CDM teams
2. Achilles immediately
3. Create Data Catalog
4. Multiple languages: Create data dictionary in English
5. Large complexity of source data: Wide and long format tables are mixed,
often redundancies
6. Local terminology: often at a different level of granularity
7. European drugs are often not included in the RxNorm vocabulary
8. Lack of concept types required for European Healthcare setting
9. Geographic information: current location entity is based on US
geographies
10. Data owners have nice visualizations that can be made available to the
entire OHDSI community
10
New IMI Initiative: EHDN
11
QuintilesIMS Data
QuintilesIMS Data Assets
European Data – to be OMOP CDMed
Patients 10.1 million 33millions 12 million
Drugs FCC ATC, ATC Ephamra, PZN Gemscripts, dm&d,
Read
Diagnosis ICD10 ICD10, ICD10GM Read
Procedure ICD10 N/A
Measurements ICD10, free form text ICD10, free form text Read
Patients Unique per refresh Unique per
practice/patient ID
Unique per patient
ID
Region French Departments East/West England, Wales,
Scotland, Ireland
Provider profile GP only GP plus some specialist GP only
Source Table Structures
Table
Name
No of
Fields
Description
AHD 25 Additional Health Data: lifestyle data, preventative healthcare,
immunizations, test results and death details.
Consult
9 Practice consultations with date, time and duration.
Dosage
3 Prescribed dosage
Medical
22 Records of symptoms, diagnoses and interventions recorded by the
primary care team.
Pack
8 Links to the Therapy table when a quantity is low, meaning the GP may
have prescribed in packs.
Pack_siz
e
2 Links to the Therapy table when a quantity is low, meaning the GP may
have prescribed in packs.
Patient
18 Information on patient characteristics and registration details.
Staff
4 Specific roles of the practice staff
Therapy
24 Prescriptions issued to patients
Thin_pra
c
9 Created for updates and provides a summary of information in each
practice
Table
Name
No of
Fields
Description
DAFR,
Back_Offic
e_data
27 All data is stored in this one table
NDF
Reference
file
37 Reference file to drugs in back_office_data.
Reference
file for
tests
5 Results or tests for patients in back_office_data
Doctor
Attributes
6 Provider level specifics
Source Data Tables No of
Fields
Description
Practice 16 Practice level information including specialties.
Patient
19 All documented patients and their demographic data.
Diagnosis
22 ICD -10 codes included in the data
Diagnosis Event Text
3 Additional Diagnosis Event Information
Therapy
47 WHO ATC5 level
Problem Events
6 All documented diagnosis/problem level data, like other_event tables
descriptions.
Prescription Evevnts
21 All documented prescription level data.
Test Prevention Events
21 All documented test level with units and value data
Adipositas Smoking Events
8 All documented obesity and smoking status
Action Events
8 All documented “notes” from physician (i.e. referrals, sick leave,
hospitalization, etc.
Lesson Learned
• Date Shifting
–Added logic to shift date of actual patient transactions
• Encrypt/De-identify Provider or Plan information within a link dataset
–Encrypted provider ID information when linked claims with EMR dataset
• Privacy ICD9/10 Codes
–Removal of ICD9/10 codes that are considered privacy issues, such as death or sexual abuse
–Using “fake” date in Death table to indicate a death
• Data unable to leave a specific country
• Pilot Patients
–Removal of patients that were are “dummy patients”
• Patients without transaction
–Adding an observation period
• Local country vocabulary mapping
• Local knowledge of each countries health system
• Knowledge of local data and business rules
• Ability to extract patient level data
• Cleaning dirty data
• Standardize measurement and unit of measure
• Source field not transferring to OMOP CDM
Drugs outside RxNorm –
RxNorm Extension
Different Drug Markets –
Different Formulations
Use of Dose Forms
19
Medicated nail lacquer – UK only
Oral Tablet
In RxNorm 3 countries 2 countries 1 country
112
47
25
30
Dose Forms
In RxNorm and
Eu
3 countries 2 countries 1 country only
360
667
1622
28850
Brand Names
Use of Brand Names
20
Cefatox – Germany only
Imodium
In RxNorm 3 countries 2 countries 1 country only
0
111
125
1591
Suppliers
Use of Suppliers
21
Granions – France only
RxNorm doesn't contain Suppliers
Introducing RxNorm Extension:
RxNorm Worldwide
22
RxNorm
201,655
RxNorm Extension
1,438,145
Ingredient
Drug
Strength
Dose Form
Brand
Name
Box size Supplier
Nicotine
Nicotine 2 mg/mL
Nicotine 2 mg/mL
Nicotine 2 mg/mL Sublingual Tablet
Nicotine 2 mg/mL Sublingual Tablet Nicorette Box of 100
Nicorette
Nicotine 2 mg/mL Sublingual Tablet Nicorette Box of 100 J&J
Sublingual Tablet
Attributes
Classes
Ingredient
Clinical Drug
Component
Clinical Drug
Branded Drug
Quantified
Branded Drug
Quantified
Branded Box
Marketed Product
“Nicotine 2 MG Sublingual Tablet [Nicorette] Box of 100 by Johnson & Johnson”
RxNorm Extension Hierarchy
European OHDSI Chapter
European OHDSI Chapter
Why a European coordinating center?
• We need to stimulate transparent and reproducible research in Europe.
• Interest in the OMOP-CDM is growing strongly, but coordination is needed to
achieve high standards in data conversion.
• Improving operability is challenging in Europe because of the large amount of
vocabularies -> major mapping effort is needed with local input.
• European training centers are needed to train all stakeholders.
• Regulators interested in OHDSI would like to have a European OHDSI office.
• A European community needs to be build that actively contributes to tool
development, adoption, and study execution.
• European funding resources are available through several program to improve
operability in the medical domain
• An annual symposium is needed to inform and enlarge the European OHDSI
community
• etc…
25
26
When and where
Department of Medical Informatics
Erasmus MC Rotterdam, The Netherlands
• March 23th 2018 OHDSI Symposium
• March 24th 2018 Tutorials
• Max 250 participants
• Poster sessions
• www.ohdsi-europe.org
• email: info@ohdsi-europe.org
27
Registration for the Symposium will open Sept 1th.
Registration for tutorials will be announced through the
website and OHDSI communication channels.
Interested in sharing European results as a keynote
speaker or on a poster? Let us know!
